[Long-term postoperative outcomes in patients with hilar cholangiocarcinoma: a single-center experience]

To evaluate long-term postoperative outcomes in patients with hilar cholangiocarcinoma.

This study included patients with hilar cholangiocarcinoma who underwent primary surgery at the Vishnevsky National Research Center of Surgery. Exclusion criteria: surgery outside our hospital, death within 90 days after surgery, distant metastases and combined hepatocellular carcinoma. Extent of surgery was determined by modern guidelines. Comparison groups included patients with different resection statuses. Statistical analysis was performed using STATISTICA 13 software.

The study included 92 patients (60 men (65.2%) and 32 women (34.8%)). Age ranged was from 18 to 83 years. Patients underwent resection of the common bile duct (13 (14.1%) cases), hemihepatectomy with bile duct resection (55 (59.8%) cases); extended hemihepatectomy with bile duct resection (16 (17.4%) cases), resection of extrahepatic bile ducts combined with PDE (1 (1.1%) case). In 32 (38.5%) cases, regional lymph node involvement was noted. We assessed all loci of tumor invasion in longitudinal and radial resection margins, as well as excised regional lymph nodes. According to our classification, resection status was as follows depending on the number of R+ loci and lymph node assessment: R₀ - 7 (8.75%), R₊₁ - 2 (2.5%), R₊₂ - 7 (8.75%), R₊₃ - 3 (3.75%), R₊₄ - 6 (7.5%), R₊₅ - 14 (17.5%), R₊₆ - 21 (25.25%), R₊₇ - 20 (25%), respectively. According to multivariate analysis, significant factors of unfavorable prognosis were TNM stage (p=0.006), tumor cells in lymph nodes (p=0.01), differentiation grade (p=0.02) and perineural invasion (p=0.03). Overall 1-, 3-, 5-, 7- and 10-year survival rates were 70%, 30%, 18%, 16%, and 16%, respectively. Survival significantly differed between R₀ and R_+1-7 resection groups (p=0.01).

Resection of extrahepatic bile ducts is radical for Bismuth-Corlette types I-II. Extensive liver resections are indicated for types III-IV. To assess resection quality, it is important to consider "clearness" of true resection margin, taking into account all loci of invasion. According to this approach, 5-year survival rate after R₀ or R_+1-2 resection is 100%.